Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) defined

Dialectical behavior therapy tends to focus on four key elements:

• Mindfulness, which focuses on improving someone's ability to be present in the moment
• Distress tolerance, which is geared toward increasing tolerance for negative emotion, rather than trying to escape it
• Emotional control, which is a strategy used to manage and change emotions that are intense and create problems in a person's life
• Interpersonal effectiveness, or behavioral skills that allow someone to communicate with others in a way that's assertive while maintaining self-respect and strengthening relationships.

When is dialectical behavior therapy (DBT) used?

Dialectical behavior therapy was originally used to treat BPD. But, it can help treat those who experience depression, post-traumatic stress disorder (PTSD), binge eating, generalized anxiety disorder, bulimia, bipolar disorder, eating disorders, and substance use. Dialectical behavior therapy is similar to cognitive behavioral therapy (CBT), but it is specially adapted for the needs of people with intense, often uncontrollable emotions. 

Rather than trying to change the emotions, dialectical behavior therapy teaches strategies for coping with them in healthy ways. Dialectical behavior therapy skills are taught in telephone crisis coaching because the coping skills learned in dialectical behavior therapy can be applied immediately to prevent harmful behavior like self-injury.

One study on the benefits of comprehensive dialectical behavior therapy for patients with bulimia found that the participants had significantly decreased bulimia nervosa symptoms after learning emotional control skills. However, more research needs to be done on how suitable dialectical behavior therapy is for eating disorders. 

DBT and skill development

DBT as a cognitive behavioral treatment

• Mindfulness, which focuses on improving someone's ability to be present in the moment
• Distress tolerance, which is geared toward increasing tolerance for negative emotion, rather than trying to escape it
• Emotional control, which is a strategy used to manage and change emotions that are intense and create problems in a person's life
• Interpersonal effectiveness, or behavioral skills that allow someone to communicate with others in a way that's assertive while maintaining self-respect and strengthening relationships.

When is DBT used in treatment? Borderline personality disorder and more

Dialectical behavior therapy for borderline personality disorder

Dr. Marsha Linehan originally developed dialectical behavior therapy in the late 1970s to treat borderline personality disorder (BPD). The original goal of this type of therapy was for a patient’s treatment team to give a patient radical acceptance as they are (using elements of comprehensive validation therapy), then help them build a “life worth living” through DBT skills training. According to the study Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations, the goal of DBT is to help a patient “engage in functional, life-enhancing behavior, even when intense emotions are present.”

With a combination of individual dialectical behavior therapy, group therapy, and phone coaching with a licensed mental health professional, patients are able to learn emotion control strategies and communication skills that lead to the ability to tolerate feelings of distress, accept their situations, and change their behaviors.

Dialectical behavior therapy for other conditions

Although dialectical behavior therapy was originally used to treat BPD, it can help treat other mental health conditions as well, such as depression, post-traumatic stress disorder (PTSD), binge eating disorder, generalized anxiety disorder, bulimia, bipolar disorder, eating disorders, drug and alcohol dependence, substance use disorder, and self-harm. Additionally, one study found DBT to be successful in reducing substance use of opioid-dependent women. Dialectical behavior therapy is similar to cognitive behavioral therapy (CBT), but it is specially adapted for the needs of people with intense, often uncontrollable emotions. 

Rather than trying to change the emotions, dialectical behavior therapy teaches strategies for coping with them in healthy ways. DBT skills are taught in telephone crisis coaching because the coping skills learned in dialectical behavior therapy can be applied immediately to prevent harmful behavior like self-injury.

Another study performed a systematic review of dialectical behavior therapy’s treatment outcome literature and discovered “preliminary evidence supporting the use of DBT skills training as a method of addressing a range of behaviors.”

Dialectical behavior therapy skills training can help people control their emotions, develop more tolerance of distress and negative emotions, remain present in the moment, improve communication, and interact with others better. Anyone can benefit from learning the skills taught in dialectical behavior therapy, but especially people who experience intense emotions. 

 Please note that the term “other mental health problems” is no longer used and should instead be replaced with “other mental health conditions”.

DBT and skill development

To provide effective treatment, dialectical behavior therapy assumes that clients are trying as best as possible but that they need to learn behaviors in different contexts. The word “dialectical” means to combine opposites. DBT therapy can teach people how to accept their intense emotions without reacting to them in a maladaptive way. People with borderline personality disorder and other mental health conditions may engage in self-injury and other harmful behaviors. DBT teaches skills to stop unwanted behaviors and replace them with positive coping skills.

Dialectical behavior therapy focuses on helping people make positive changes in their life by controlling intense emotional reactions. Dialectical behavior therapy aims to teach these different skills, which may allow a person to navigate situations in everyday life or manage challenges that get too big. These skills, according to Linehan, can be a huge part of building a fulfilling life. Being fully aware of their emotions can help people with a personality disorder manage intense emotions in day-to-day life. 

People who have BPD can have extreme emotions, which can be difficult to manage. These can be intense, uncontrollable emotions that become a problem when someone with BPD is interacting with other people, including friends, romantic partners, and even their own family.

Individual therapy sessions in a dialectical behavior therapy program tend to be influenced by the philosophy of dialectics, which often focuses on balancing opposites. A therapist might work with you to find different ways to balance different perspectives that are influencing you. This work may help you to avoid extremes in the way you think. In clinical psychology, dialectical behavior therapy training may provide you with distress tolerance skills, coping skills, and thought reframing.

This type of therapy may consist of both group work and one-on-one sessions. The therapist may occasionally seem like a coach to the client. The goal of individual sessions is to keep the person motivated, help them apply the learned skills in their life, and address any obstacles that might arise during treatment. Therapists may use a variety of methods, including role-playing, experiments, and homework assignments. Doing any homework assignments, the therapist assigns can help you get the most out of dialectical behavior therapy. 

There may be one or more licensed mental health professionals involved in treatment. Some facilities offer a consultation team to provide comprehensive dialectical behavior therapy treatment. The DBT consultation team may include a primary healthcare provider, behavioral tech, nurses, therapists, and other professionals. The following are some skills that you may work on during dialectical behavior therapy.

Mindfulness

During dialectical behavior therapy sessions, a therapist may help a client become more mindful of any triggers that cause emotional distress or any situations that can cause a desire to lash out and an inability to accept change. Accepting change tends to be a significant part of this type of therapy.

Distress tolerance

When it comes to the skill of distress tolerance, the therapist may focus on helping the person try to tolerate negative emotions. Oftentimes, a person may flee negative situations or lash out, which tends to breed more negativity. With dialectical behavior therapy, a therapist may help the client tolerate their current emotions and handle distress more skillfully.

Emotion control skills

Emotion control skills consist of strategies that can be used to help a person become more emotionally balanced. This part of the treatment targets one’s ability to manage emotions in order to help prevent blowups, allowing them to harness control over their emotions.

Interpersonal effectiveness

Interpersonal effectiveness training aims to help a person become more assertive in their relationships. This component of DBT may help them to get better at communicating and have a stronger, healthier relationship not just with themselves but also with other people.

Group sessions using dialectical behavior therapy (DBT) with a therapist

This group aspect of dialectical behavior therapy focuses mostly on learning how to practice these skills. The one-on-one aspect of training tends to focus on the why, but group work allows you to practice your skills. Other people have their own experiences, and they may know of something that can help you cope with challenging situations better. Also, group work can give you a better, more reliable support network. Usually, one trained therapist leads all of this work, and they practice different skills and exercises with group participants. 

The group component of DBT usually lasts about two hours, with the group meeting weekly for approximately six months, depending on the needs that people have. DBT can be conducted in different ways, depending on the participants and the therapist. Some people don't need skills groups, but others may find that they work better with others. 

Group sessions can have many benefits, including social support and encouragement from the other group members. Practicing the skills learned in DBT with others can help increase self-esteem and confidence. However, how suitable DBT group sessions are for people may depend on several factors. People with social anxiety may feel uncomfortable in a group setting and prefer individual DBT. The effectiveness of group sessions may depend on the participant’s willingness to participate. 

If you’re interested in trying DBT, you can search for "DBT therapy near me" with an experience in this therapeutic modality. Alternatively, you might try DBT through online therapy, which research has shown to be just as effective as in-person sessions. With an online platform like BetterHelp, you can speak with a licensed therapist without leaving home, which may be more comfortable than going to a therapist’s office if this is your first time speaking with a therapist. 

With BetterHelp, you can communicate with a DBT therapist via phone or video chat at a time that suits your schedule. Also, you can contact your therapist in between sessions via in-app messaging, and they’ll get back to you as soon as they can.